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Summary
Position Purpose
We are currently hiring for a Medical Reviewer II to join BlueCross BlueShield of South Carolina. In this role as a Medical Reviewer II, you will perform medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines, document decisions using indicated protocol sets or clinical gu...

Summary
Position Purpose
We are currently hiring for a Medical Reviewer II to join BlueCross BlueShield of South Carolina. In this role as a Medical Reviewer II, you will perform medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines, document decisions using indicated protocol sets or clinical gu...

As a trusted global transformation partner, Welocalize accelerates the global business journey by enabling brands and companies to reach, engage, and grow international audiences. Welocalize delivers multilingual content transformation services in translation, localization, and adaptation for over 250 languages with a growing network of over 77,000 in-country linguistic resources. Driving innov...

Overview
Empower AI is AI for government. Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions. Our proven Empower AI Platform® provides a practical, sustain...

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Perform clinical/coding medical claim review to ensure compliance with coding practices through a...

Summary
We are currently hiring for a Senior Medical Reviewer to join CGS, a Celerian Group Company and subsidiary of BlueCross BlueShield of South Carolina. In this role you will Act as Team Lead for specialty programs, medical review, utilization management, and case management areas by providing assistance and support to unit supervisor/manager by giving direction/guidance/training t...

Summary
We are currently hiring for a Senior Medical Reviewer to join CGS, a Celerian Group Company and subsidiary of BlueCross BlueShield of South Carolina. In this role you will Act as Team Lead for specialty programs, medical review, utilization management, and case management areas by providing assistance and support to unit supervisor/manager by giving direction/guidance/training t...

Summary
We are currently hiring for a Senior Medical Reviewer to join CGS, a Celerian Group Company and subsidiary of BlueCross BlueShield of South Carolina. In this role you will Act as Team Lead for specialty programs, medical review, utilization management, and case management areas by providing assistance and support to unit supervisor/manager by giving direction/guidance/training t...

Valor Healthcare is looking for a Medical Reviewer to join our team on a PRN or per diem basis supporting arbitration of Medicare/Medicaid evaluations.
Schedule: This position is typically 4 hour a week with flexible hours depending on candidate's availability. Although, there may be a few instances where meetings may take place during the work day.
The focus of Risk Adjustment Data Validat...

Summary
Join our team serving active and retired US military members and their covered family members. We strive to ensure that these dedicated individuals and their loved ones receive high-quality care administered as economically as possible and in accordance with current evidence-based care guidelines. As part of our expanding team of medical reviewers, you will evaluate the medical ...

Job Summary:
The Program Integrity Medical Coding Reviewer III generates comprehensive and concise in-depth reporting and analysis to track performance related to the Pre-Pay and Post-Paid Processes.
Essential Functions:
* Provide Provider Pre Pay production and progress reports and coordinate with management and team on recommendation for further actions and/or resolutions in order to inc...

Company Overview
Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.
Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership ...

Summary
Join our team serving active and retired US military members and their covered family members. We strive to ensure that these dedicated individuals and their loved ones receive high-quality care administered as economically as possible and in accordance with current evidence-based care guidelines. As part of our expanding team of medical reviewers, you will evaluate the medical ...

Current Employees:
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The Concurrent Quality Reviewer of our hospital reviews documentation in the electronic medical...